Cubic crystals in an x-ray polarization-splitting geometry

Hexagonal and cubic crystals contain paired sets of internal planes that reflect the linearly polarized components of certain x rays into two separate, perpendicular directions. For the cubic crystals, two distinct crystal orientations provide the same polarization-splitting geometry. One of the orientations may have advantages for plasma spectroscopy by suppressing unwanted reflections. This paper demonstrates the two orientations with a germanium crystal and K characteristic lines from copper and zirconium.

Comparison of High Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh, Bangladesh

Pregnancy is accompanied by changes in the maternal lipoprotein metabolism that may serve to satisfy the nutritional demands of the fetus in addition to the energy requirements of the mother. Early pregnancy is considered the anabolic phase, characterized by increased hepatic production of triglycerides and enhanced removal of triglycerides from the circulation, resulting in an increased deposition of fat in maternal adipose tissue. Late pregnancy is referred to as the catabolic phase, the release of free fatty acids from adipocytes is enhanced due to both relative insulin resistance and stimulation of hormones. Although it is known that cholesterol rises in pregnancy, at present it is not routinely measured or treated. However, a growing body of evidence from animal and human studies suggests adverse consequences of high cholesterol levels in pregnancy. High lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh from July 2011 to December 2012 to compare the changes in high density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hours. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has been found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum High Density Lipoprotein (HDL) cholesterol increases in second trimester (48.71±7.61mg/dl) than third trimester (47.01±7.45mg/dl) of Pregnancy. So, Lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

Outcome of Surgery in Chronic Inactive Mucosal Otitis Media

Chronic otitis media is a common condition seen in patients attending the otorhinolaryngology Department. The discharging ear presents the otologists with the dilemma of operating on it or not. The aim of the this cross-sectional observational study was to find out the outcome of surgery in chronic inactive mucosal otitis media and was conducted on 62 patients of either sex in the age group of 15-60 years in the Department of ENT and Head Neck surgery, Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh From July 2015 to January 2016. Pre and post operative hearing assessment was done with pure tone audiometry (PTA). Post operative graft status also noted. All the information's were recorded in the fixed protocol. Collected data were classified, edited, coded and entered into the computer for statistical analysis by using updated computerized program SPSS-19. Among 62 cases the mean age were 36.79±10.33 in chronic inactive mucosal otitis media. Majority of the study population were in age group of between 15-25 in this group of which was 16(51.6%). Male were 36(58.06) and 26(41.94) were female. All patients presented with history of otorrhoea in this group, 52(83.87%) had hearing impairment in chronic inactive mucosal otitis media, 30(48.39%) involved in right ear and 26(41.94%) involved in left ear and 06(9.68%) in both ear in chronic inactive mucosal otitis media. Majority of perforation were medium in size in this group of which was 30(48.39%). anterior perforation was 24(38.71%), posterior perforation 28(45.16%) and subtotal 10(16.13%) in chronic inactive mucosal otitis media. Sixty two (100%) cases underwent myringoplasty. Post-auricular approach used in most of operation in this group of which was 60(96.77%). Preoperative air conduction threshold 32(51.61%) were in between 31-45 dB in myringoplasty group (p<0.05) that was statistically significant. Postoperative air conduction threshold 30(48.39%) were between 16-30 dB in myringoplasty group (p<0.05) that was statistically significant. Difference between preoperative and postoperative air conduction threshold mean difference was 11.38 dB and 36.75±5.84 and 25.37±7.46 respectively (p<0.001) in myringoplasty group. Hearing gain was 42(67.74%) in myringoplasty (p>0.05) that was not statistically significant. Graft uptake in myringoplasty was 52(83.9%). Graft failure in myringoplasty was 10(16.1%). post operative complication was tinnitus in 12(19.35%) cases in myringoplasty. Success rate was more in case of posterior perforation than anterior and subtotal perforation in both chronic inactive mucosal otitis media which was 92.86%. Success rate was more in case of medium size perforation than subtotal perforation in chronic inactive mucosal otitis media which was 86.67%. Success rate was (100%) in small perforation in this group. From this study it can be concluded that myringoplasty is a valid treatment modality for chronic inactive mucosal otitis media to achieve an intact tympanic membrane and to gain hearing.

A phase II study of temsirolimus added to low-dose weekly carboplatin and paclitaxel for patients with recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC)

Background

Activating events along the PI3K/mTOR pathway are common in head and neck squamous cell carcinomas (HNSCC), and preclinical studies suggest additive or synergistic effects when combining mTORC1 inhibitors with carboplatin and paclitaxel chemotherapy.

Patients and methods

In this single-institution phase II study, the combination of temsirolimus 25 mg, carboplatin AUC 1.5, and paclitaxel 80 mg/m2 administered on days 1 and 8 of a 21-day cycle was evaluated in 36 patients with recurrent and/or metastatic (R/M) HNSCC. The primary end point was objective response rate after two cycles of treatment. Secondary end points include the safety and tolerability profile and overall survival. Correlative studies with exome mutational analysis were performed in pre-treatment biopsy samples from 21 patients.

Results

Fifteen (41.7%) patients had an objective response, which were all partial responses, and 19 (52.3%) patients had stable disease as best response. The two patients who were designated as 'non-responders' were removed from study prior to two cycles of treatment, but are included in the efficacy and safety analyses. The median duration on study was 5.3 months and the median progression-free survival and overall survival were 5.9 months (95% confidence interval, 4.8-7.1) and 12.8 months (95% confidence interval, 9.8-15.8), respectively. The most common grade 3 and 4 adverse events were hematologic toxicities. Three (3.8%) patients developed neutropenic fever on study. Three of four patients with PIK3CA mutations experienced tumor regressions, and responses were also seen in patients with other genetic alterations in the PI3K/mTOR pathway.

Conclusion

The combination of temsirolimus with low-dose weekly carboplatin and paclitaxel appears to have meaningful clinical efficacy in the treatment of R/M HNSCC. This regimen has a relatively high response rate compared to other treatments evaluated in R/M HNSCC, and potential associations with genetic alterations in the PI3K/mTOR pathway should be further explored.

Spatially resolved single crystal x-ray spectropolarimetry of wire array z-pinch plasmas

A recently developed single-crystal x-ray spectropolarimeter has been used to record paired sets of polarization-dependent and axially resolved x-ray spectra emitted by wire array z-pinches. In this measurement, two internal planes inside a suitable crystal diffract the x-rays into two perpendicular directions that are normal to each other, thereby separating incident x-rays into their linearly polarized components. This paper gives considerations for fielding the instrument on extended sources. Results from extended sources are difficult to interpret because generally the incident x-rays are not separated properly by the crystal. This difficulty is mitigated by using a series of collimating slits to select incident x-rays that propagate in a plane of symmetry between the polarization-splitting planes. The resulting instrument and some of the spatially resolved polarized x-ray spectra recorded for a 1-MA aluminum wire array z-pinch at the Nevada Terawatt Facility at the University of Nevada, Reno will be presented.

Challenges in culture-negative cases of Madurella mycetomatis: A case report re-accentuating PCR as an essential diagnostic tool

Identification of dematiaceous fungi responsible for black-grain mycetoma has remained cumbersome and time consuming for years leading to delayed diagnosis and thereby increased agony to patients. Moreover, difficult morphology of some of these fungi demanding enough expertise for species identification in addition to culture-negativity has often led to misdiagnosis and hence inapt treatment to the patients. We report the identification of Madurella mycetomatis from culture-negative black granules discharged from foot nodular lesions of a 27 years old male using PCR followed by sequencing of the internal transcribed spacer region. The patient's lesions were successfully treated using a combination of itraconazole (200mg) and terbinafine (250mg), confirming our diagnosis. Our case study proves the clinical value of PCR as the best, rapid and accurate diagnostic method for the identification of Madurella mycetomatis and related fungi, particularly in culture-negative cases.

The 67P/Churyumov-Gerasimenko observation campaign in support of the Rosetta mission

We present a summary of the campaign of remote observations that supported the European Space Agency's Rosetta mission. Telescopes across the globe (and in space) followed comet 67P/Churyumov-Gerasimenko from before Rosetta's arrival until nearly the end of the mission in September 2016. These provided essential data for mission planning, large-scale context information for the coma and tails beyond the spacecraft and a way to directly compare 67P with other comets. The observations revealed 67P to be a relatively 'well-behaved' comet, typical of Jupiter family comets and with activity patterns that repeat from orbit to orbit. Comparison between this large collection of telescopic observations and the in situ results from Rosetta will allow us to better understand comet coma chemistry and structure. This work is just beginning as the mission ends-in this paper, we present a summary of the ground-based observations and early results, and point to many questions that will be addressed in future studies.This article is part of the themed issue 'Cometary science after Rosetta'.

Ultrasonographic Evaluation of Palpable Breast Mass and Correlation with Histopathology

Breast cancer is the most common malignancy in women and the second most common cause of cancer-related mortality. The distinction by physical examination of physiologic nodularity from abnormal masses can be difficult, while the clinical differentiation of a malignant mass from a benign one is difficult; the medical as well as potential legal consequences of missing a palpable carcinoma are high. There are significant number of reported cases of false-negative findings on mammography and the great desire not to miss a malignant lesion in the early stage of disease lead to aggressive biopsy, but the biopsy rate for cancer is only 10.0% to 30.0%. This means that 70.0% to 90.0% of breast biopsies are performed for benign diseases, which induce unnecessary patients discomfort and anxiety in addition to increasing costs to the patient. Clearly, there is a great need for development of additional reliable methods to complement the existing diagnostic procedures to avoid unnecessary biopsy. This cross sectional study was carried out on 43 patients having palpable breast mass, attended in the Department of Radiology and Imaging Mymensingh Medical College Hospital, Mymensingh from 1st January 2012 to 31st December 2013 for the period of two year. These patients were evaluated by USG at the Department of Radiology and Imaging and histopathological examination at the Department of Pathology of the same College to confirm the diagnosis. In diagnosis of malignant mass by USG, 9(20.9%) cases were diagnosed as malignant and 34(79.1%) cases as other than malignant. Eight out of 9 were sonographically diagnosed as malignant lesions also proved as malignant lesion by histopathology and 1 other than malignant. Out of 34 sonographically diagnosed cases of other than malignant lesions 32 were proved histopathologically and 2 did not match with sonographic findings. USG, in diagnosis of malignant lesion, sensitivity was 80.0%, specificity 96.97%, positive predictive value (PPV) (88.89%), negative predictive value 94.12% and accuracy was 93.02% and comparable to other study. In diagnosis of benign lesion by USG, sensitivity was 96.97%, specificity 80.0%, positive predictive value (PPV) (94.12%), negative predictive value 88.89% and accuracy was 93.02%. So, USG is an appropriate imaging method for diagnosis & differential diagnosis of palpable breast mass.

Development of a spectroscopic technique for simultaneous magnetic field, electron density, and temperature measurements in ICF-relevant plasmas

Spectroscopic techniques in the visible range are often used in plasma experiments to measure B-field induced Zeeman splitting, electron densities via Stark broadening, and temperatures from Doppler broadening. However, when electron densities and temperatures are sufficiently high, the broadening of the Stark and Doppler components can dominate the emission spectra and obscure the Zeeman component. In this research, we are developing a time-resolved multi-axial technique for measuring the Zeeman, Stark, and Doppler broadened line emission of dense magnetized plasmas for Z-pinch and Dense Plasma Focus (DPF) accelerators. The line emission is used to calculate the electron densities, temperatures, and B-fields. In parallel, we are developing a line-shape modeling code that incorporates the broadening effects due to Stark, Doppler, and Zeeman effects for dense magnetized plasma. This manuscript presents the details of the experimental setup and line shape code, along with the results obtained from an Al iii doublet at the University of Nevada, Reno at Nevada Terawatt Facility. Future tests are planned to further evaluate the technique and modeling on other material wire array, gas puff, and DPF platforms.

Comparison of Low Density Lipoprotein Cholesterol Level in Second and Third Trimester of Pregnancy in Mymensingh Region of Bangladesh

Altered metabolic and hormonal status of the body in pregnancy leads to changes in lipid profile. High Lipid profile, a major factor behind atherosclerosis may leads to unconsciousness. To avoid such problems during pregnancy this longitudinal study was carried out in the Department of Biochemistry, Mymensingh Medical College in co-operation with the Department of Obstetrics and Gynaecology, Mymensingh Medical College Hospital and Community Based Medical College Hospital, Bangladesh during the period from July 2011 to December 2012 to compare the changes in low density lipoprotein cholesterol level during 2nd and 3rd trimester of pregnancy. A total of one hundred subjects were participated in this study comprising of second and third trimester of pregnancy. All subjects were made to fast overnight at least for a minimum of 8 hrs. Blood samples were taken and analyzed by enzymatic colorimetric kit method. Pregnancy has being found to be associated with changes in lipid profile and this differs with each trimester. The average results were analyzed with respect to each pregnancy for the whole group. The study proves that serum Low Density Lipoprotein (LDL) cholesterol increases in third trimester (174.83±13.78 mg/dl) than second trimester (156.77±7.96 mg/dl) of pregnancy. Therefore, lipid profile estimation and monitoring should be made as a part of routine investigation during antenatal period.

A phase II study of axitinib (AG-013736) in patients with incurable adenoid cystic carcinoma

BACKGROUND

Recurrent/metastatic adenoid cystic carcinoma (ACC) is an incurable disease with no standard treatments. The majority of ACCs express the oncogenic transcription factor MYB (also c-myb), often in the context of a MYB gene rearrangement. This phase II trial of the tyrosine kinase inhibitor (TKI) axitinib (Pfizer) tested the hypothesis that targeting pathways activated by MYB can be therapeutically effective for ACC.

PATIENTS AND METHODS

This is a minimax two-stage, phase II trial that enrolled patients with incurable ACC of any primary site. Progressive or symptomatic disease was required. Patients were treated with axitinib 5 mg oral twice daily; dose escalation was allowed. The primary end point was best overall response (BOR). An exploratory analysis correlating biomarkers to drug benefit was conducted, including next-generation sequencing (NGS) in 11 patients.

RESULTS

Thirty-three patients were registered and evaluable for response. Fifteen patients had the axitinib dose increased. Tumor shrinkage was achieved in 22 (66.7%); 3 (9.1%) had confirmed partial responses. Twenty-five (75.8%) patients had stable disease, 10 of whom had disease stability for >6 months. The median progression-free survival (PFS) was 5.7 months (range 0.92-21.8 months). Grade 3 axitinib-related toxicities included hypertension, oral pain and fatigue. A trend toward superior PFS was noted with the MYB/NFIB rearrangement, although this was not statistically significant. NGS revealed three tumors with 4q12 amplification, producing increased copies of axitinib-targeted genes PDGFR/KDR/KIT. Two 4q12 amplified patients achieved stable disease for >6 months, including one with significant tumor reduction and the longest PFS on study (21.8 months).

CONCLUSIONS

Although the primary end point was not met, axitinib exhibited clinical activity with tumor shrinkage achieved in the majority of patients with progressive disease before trial enrollment. Analysis of MYB biomarkers and genomic profiling suggests the hypothesis that 4q12 amplified ACCs are a disease subset that benefit from TKI therapy.

A Novel Methodology for Applying Multivoxel MR Spectroscopy to Evaluate Convection-Enhanced Drug Delivery in Diffuse Intrinsic Pontine Gliomas

BACKGROUND AND PURPOSE

Diffuse intrinsic pontine gliomas are inoperable high-grade gliomas with a median survival of less than 1 year. Convection-enhanced delivery is a promising local drug-delivery technique that can bypass the BBB in diffuse intrinsic pontine glioma treatment. Evaluating tumor response is critical in the assessment of convection-enhanced delivery of treatment. We proposed to determine the potential of 3D multivoxel (1)H-MR spectroscopy to evaluate convection-enhanced delivery treatment effect in these tumors.

MATERIALS AND METHODS

We prospectively analyzed 3D multivoxel (1)H-MR spectroscopy data for 6 patients with nonprogressive diffuse intrinsic pontine gliomas who received convection-enhanced delivery treatment of a therapeutic antibody (Phase I clinical trial NCT01502917). To compare changes in the metabolite ratios with time, we tracked the metabolite ratios Cho/Cr and Cho/NAA at several ROIs: normal white matter, tumor within the convection-enhanced delivery infusion site, tumor outside of the infused area, and the tumor average.

RESULTS

There was a comparative decrease in both Cho/Cr and Cho/NAA metabolite ratios at the tumor convection-enhanced delivery site versus tumor outside the infused area. We used MR spectroscopy voxels with dominant white matter as a reference. The difference between changes in metabolite ratios became more prominent with increasing time after convection-enhanced delivery treatment.

CONCLUSIONS

The comparative change in metabolite ratios between the convection-enhanced delivery site and the tumor site outside the infused area suggests that multivoxel (1)H-MR spectroscopy, in combination with other imaging modalities, may provide a clinical tool to accurately evaluate local tumor response after convection-enhanced delivery treatment.

Abstract P4-14-21: A phase I trial of ganetespib (heat shock protein 90 inhibitor) in combination with paclitaxel and trastuzumab in patients with human epidermal growth factor receptor-2 positive (HER2+) metastatic breast cancer (MBC)

Introduction: Targeted therapies in HER2+ MBC significantly improve outcomes but efficacy is limited by therapeutic resistance. HSP90 is a molecular chaperone involved in the stability and function of multiple signaling onco-proteins. HER2 is an acutely sensitive HSP90 client and HSP90 inhibition can overcome trastuzumab resistance. Our group reported objective responses with 17-AAG plus trastuzumab in HER2+ MBC. Ganetespib, a synthetic, second generation HSP90 inhibitor has increased potency and tolerability compared with earlier agents. We reported anti-tumor activity in metastatic HER2+ and triple negative breast cancer with single agent ganetespib. Preclinically, HSP90 inhibition has synergistic anti-tumor activity with taxanes and trastuzumab. This study will define the MTD and RP2D of ganetespib plus paclitaxel and trastuzumab in HER2+ MBC.

Methods: In this 3+3 phase I dose escalation study, patients with trastuzumab-resistant HER2+ MBC receive weekly trastuzumab and paclitaxel (80mg/m2) with ganetespib on day 1, 8, 15 of a 28 day cycle. HR+ positive patients are required to have at least one prior line of endocrine therapy. DLT of ganetespib monotherapy is diarrhea and therefore patients receive prophylactic anti-motility agents. Based on prior experience with ganetespib plus docetaxel in NSCLC, only 3 dose levels of ganetespib were explored: 100mg/m2, 150mg/m2 and a 3rd cohort of 125mg/m2, if needed. Secondary endpoints include evaluation of effects of ganetespib on the pharmacokinetics (PK) of paclitaxel and preliminary efficacy assessment.

Results: The dosing cohorts (100 mg/m2 (n=3) and 150 mg/m2 (n=6)) have been completed without any DLTs. Median age was 46 years (range 29-65), median prior lines of chemotherapy and anti-HER2 therapy were 3 (range 2-6) and 3 (range 2-4) respectively, including prior pertuzumab in 9/9 and T-DM1 in 8/9 patients. There were no grade 3/4 adverse events (AEs) related to ganetespib. Most common AEs related to ganetespib were diarrhea, fatigue, anemia and rash. Paclitaxel PK data available from 6/9 patients are not appreciably different from those reported in literature. Overall response rate was 25% (2/8 had PR in 150 mg/m2 cohort; 1 patient was not evaluable), SD in 63% (5/8), and clinical benefit rate (CR+PR+SD&gt;24 weeks) was 50% (4/8). 3 patients remain on study.

Conclusion: The RP2D of ganetespib is 150mg/m2 in combination with paclitaxel and trastuzumab. The combination was safe and well tolerated. Updated PFS and PK data will be presented. Despite prior taxanes, pertuzumab and T-DM1, clinical activity of this triplet regimen in this heavily pre-treated cohort is very promising and together with our prior experience with 17-AAG plus trastuzumab and single agent ganetespib warrants further study in HER2+ MBC. A phase 2 trial is being planned in trastuzumab-refractory HER2+ MBC who have progressed on prior pertuzumab and T-DM1. Additionally, the protocol is amended to assess the safety of ganetespib in combination with paclitaxel, trastuzumab and pertuzumab in the first-line setting.

Citation Format: Jhaveri K, Teplinsky E, Chandarlapaty S, Solit D, Cadoo K, Speyer J, D'Andrea G, Adams S, Patil S, Haque S, Friedman K, Neville D, Esteva F, Hudis C, Modi S. A phase I trial of ganetespib (heat shock protein 90 inhibitor) in combination with paclitaxel and trastuzumab in patients with human epidermal growth factor receptor-2 positive (HER2+) metastatic breast cancer (MBC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-21.

Oral thromboprophylaxis in patients with ankle fractures immobilized in a below the knee cast

BACKGROUND

Lower-limb immobilization has been implicated as an etiologic factor for a venous thromboembolism (VTE). Most of the current literature encourages the use of thromboprophylaxis with injectable low-molecular-weight heparin (LMWH) in trauma patients. Injectable anticoagulants have inherent problems of producing pain and bruising. They are also difficult to administer, leading to low compliance. Oral anticoagulants are therefore gaining popularity for use as thromboprophylactic agents in hip and knee arthroplasty patients. There are not enough studies in the literature, however, to support their use in ambulatory trauma patients whose ankle fractures are being managed nonoperatively on an outpatient basis.

METHODS

This study evaluated the efficacy of oral anticoagulants for preventing VTE in ambulatory trauma patients who required temporary lower limb immobilization for non-operative management of their ankle fractures. A total of 200 consecutive patients who presented to the fracture clinic with an ankle fracture that was managed in a plaster cast were included in this study. These patients were assessed for risk of developing VTE and high risk patients were administered an oral anticoagulant to prevent VTE.

RESULTS

There was only one case of an isolated distal DVT among the 200 patients.

CONCLUSIONS

This study shows that an oral anticoagulant was a safe alternative to injectable LMWH as a thromboprophylactic agent for ambulatory trauma patients requiring temporary lower limb immobilization for non-operative management of an ankle fracture.

Role of sonohysterography in evaluation of abnormally thickened endometrium causing abnormal uterine bleeding with histopathological correlation

This prospective randomized study was carried out in the department of Radiology and Imaging in collaboration with the department of Obstetrics and Gynecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag and Dhaka Medical College Hospital (DMCH) during the period of January 2003 to December 2004. The aim of this study was to establish sonohyterography as a sensitive tool and superior to Transvaginal Sonography (TVS) for detection of endometrial pathology in women with abnormal uterine bleeding (AUB) and its validity by determining sensitivity, specificity, accuracy, positive predictive value and negative predictive value. For this purpose, a total number of 40 patients who had thickened endometrium (cut off level <15 mm for pre menopausal and <5 mm for post menopausal patients) detected on transabdominal or transvaginal sonography were selected. TVS and TV-SH were done in all these patients and findings were then compared with the final histopathological diagnosis. In our study, we found TV-SH has sensitivity of 100%, specificity of 80% and accuracy of 97.5 % compared to TVS (94 %, 66.66 % and 90 % respectively) in detection of endometrial pathology in women with AUB. TV-SH can thus be regarded as one of the most sensitive, specific and accurate modality in detecting and excluding endoluminal masses as the cause of AUB. It can be considered as the initial examination in the evaluation of all women with AUB. DOI: http://dx.doi.org/10.3329/bmrcb.v40i1.20322 Bangladesh Med Res Counc Bull 2014; 40: 10-14

Body mass index and waist/height ratio for prediction of severity of coronary artery disease

Background

To determine whether waist-to-height ratio correlates with coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by coronary angiography in Bangladeshi population.

Methods

This cross sectional study was done on patients in Department of Cardiology in DMCH and those referred in the cath-lab of the Department of Cardiology for CAG during November 2009 to October 2010 involving 120 patients. They were divided into group-A (with coronary score ≥7) and group-B (coronary score <7) depending on Gensisni score.

Result

There were no statistically significant difference regarding the distribution of age, sex and clinical diagnosis and parameters between the two groups. The mean age of patients was 51.7 ± 8.2 years and 48.8 ± 9.1 years in Group A and Group B respectively with a male predominance in both the groups. Patients in group A had higher BMI ≥25 and waist to height ratio (≥0.55) than Group B which showed a statistically significant association (p < 0.001). Though a significant positive correlation (r = 0.296, p = 0.006) was observed between BMI and Coronary artery disease score in group A patients, scenario was reverse fro group B (r = 0.076, p = 0.659). The statement was also true for Waist-to-height ratio and Waist-to-height ratio with BMI. Multivariate analysis also yeilded that a patient with BMI ≥25 kg/m² and waist-to height ratio of ≥0.55 are 3.06 times and 6.77 times, more likely to develop significant coronary artery disease respectively.

Conclusion

The waist-to-height ratio showed better correlation with the severity of coronary artery disease than the BMI.